Hearts & Hostility: Public Health in Conflicts

The public health effect in warzones is more than a body count. Jammu and Kashmir, a region contested by Pakistan, India, and China, is one well-studied example of a region occupied by military forces, where both intranational independence movements and international territory disputes often bring violence. Psychiatrists in the Kashmir valley found their number of patients rising and, trying to understand, conducted a survey of some of the area’s population. They discovered that about fifty percent of respondents were suffering from depression and hypertension. Of these respondents, eightyfive percent of men and eighty-nine percent of women with hypertension traced their condition back to the conflict. Here, “conflict” does not necessarily refer to active fighting, but instead a slow simmer of tensions often breaking out in violence.

In the West Bank and Gaza Strip regions of Palestine occupied by Israel, a joint study by Khaled Qlalweh and Mohammed Duraidi of the Palestinian Statistics Bureau and Henrik Brønnum-Hansen of the University of Copenhagen found that from 2006 to 2010 the expected male lifetime without a chronic disease had decreased by an average of 1.6 years—particularly due to hypertension and diabetes. The expected female lifetime without a chronic disease increased by 1.3 years, though not necessarily without the aforementioned diseases. Citing “lifestyle factors and the impact of military occupation,” the authors conclude that the gender-correlated differences point toward a gendered nature of the conflict rather than indicate that the diseases are not suitable for examining population health.

These areas’ conflicts are vastly different and particular to their regions’ histories. They share only a hostile presence of occupying forces, and there is a traceable trend: hypertension increases. Of the known risk factors for hypertension, including sleep apnea, high cholesterol, and poor diet, the intuitive candidate is stress. People who aren’t physically injured in confrontations with these occupiers still live under great stress, in the form of mental and emotional traumas.

Abigail Sewell and Kevin Jefferson, sociologists at Emory University, used data from the New York City Community Health Survey and the NYC Stop, Question, and Frisk dataset to analyze impacts of routine police presence and aggression on public health. They found that rather than death by the barrel of a gun, most police-enacted violence takes shape as a community-wide decline in health. The specific effects of heavy police presence on health indicators (diabetes, hypertension, heavier body weight, and asthma attacks) varies with socioeconomic and racial composition of a neighborhood; but what remains constant across neighborhoods is that likelihood of a stop culminating in a frisk correlates “positively and statistically significant[ly]” with presence of all indicators in neighborhood residents.

Simply put, the more intrusively police asserts its presence in a neighborhood, the worse the health in the area. Even when the New York researchers compared similar neighborhoods to control for complex variables like poverty, a high likelihood of frisking re mained securely linked with an increase in hypertension cases. This correlation between hostile groups in power and hypertension cases in New York parallels the data from Kashmir and Palestine.

So how can we understand police presence as a similar stressor to occupation?

As agents of the state, police regulate society as they see fit. The slave patrol was a forerunner to the American police system, and racialized applications of the law display that legacy now. In an article written in the wake of a police officer’s killing of Eric Garner in New York, Civil Rights Attorney Ron Kurby stated: “The NYPD does not care how frequently a police officer is sued or how many civilian complaints are justified or substantiated.” Faced with pressure to push out the perpetrators of violent acts, they close ranks around their own instead of internalizing the grievances of the community they purportedly serve. Eugene O’Donnell, a former NYPD officer, phrases it differently: “People who do police work understand that it’s very messy. Brutality is part of the police job.” Here, O’Donnell analyzes the police job as absorbing a necessary evil: some people must be hurt in order to protect others. The Sewell and Jefferson study suggested that high stop rates in mixed-race neighborhoods are a protective factor for white residents, but a risk factor for non-white residents. If this tradeoff is inherent to policing, it represents a continuous and predictable damage to the people expended. The police becomes a hostile force.

We’ve found patterns between data from Kashmir, Palestine, and New York City, but this trend should not be unique to these locations. Data from other American cities could strengthen this correlation. Proving causation is difficult, but a strong correlation can warrant action in its own right. In the state of Tibet, many of whose people consider themselves occupied by China, a 2011 multi-hospital study uncovered an inexplicable clustering of hypertension among seemingly unrelated groups of people. If the pattern described here becomes established in the public health community, Tibetan researchers will have another avenue to explore: do the groups with hypertension more strongly feel the pressure of Chinese occupation?

These studies give weight to the specific factor of hostile occupation in poor community health, as distinct from other variables like generational poverty or access to healthcare. This analysis opens a scientific lens in the conversation evaluating the oppressive effects of policing, and pushes against mainstream tendencies to excuse the violence.